Birth wars: the politics of childbirth

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Birth is divisive. It divides women from men, and women from women. It requires of the body an opening up, at times a cutting, or a tearing apart. “But to let the baby out,” writes Maggie Nelson in The Argonauts, “you have to be willing to go to pieces.”

So going to pieces is precisely what women do.

To be of woman born is a universal experience, yet women themselves remain a diffuse, fractured group. “What is a woman, anyway?” is still considered a deep, meaningful question to ask. The polite answer is, of course, “whatever anyone wants it to be”. More than that would close off the vessel, seal the hole, glue back together the broken shell. There’s a sense in which women are simply not meant to be whole. We need to be in pieces so that men can survive intact.

I have given birth three times and each experience has a different colour. For the first, I lay in the bedroom of our terraced house, staring at the brown wardrobe opposite, trying to think my way beyond pain. With each contraction I pictured a hill (“some women like to imagine themselves ascending and descending a mountain peak,” said the birthing guide) but it was grey, dull and unimpressive. Then just as the pain peaked, I’d see a figure emerging over the crest, a grey-faced man in a top hat and black overcoat. Jack the Ripper, eviscerator of wombs, an involuntary visualisation.

For the second I remember a nauseous green, leaves and trees on the drive to the hospital, surprised that I’d forgotten just how much the pain takes you right in the centre. Then the bluest of skies as I felt the ground beneath me and heard the first cries as my son emerged right there in the middle of the car park. The most perfect moment, no pain at all, although I tried to remember for next time.

The final time we were stuck in traffic beside the orange display window of a grocery. I covered my eyes to avoid seeing the oversized bottles of Lucozade and wine. My already-born children were in the back of the car, taking a detour from the first day of term school run. I couldn’t explain to them why I was not myself, why I couldn’t even be touched.

As Maggie Nelson writes of her own arrival at hospital, “everything around me is normal and inside I am in the pain cavern”. You are on your own, inaccessible. That other people cannot feel as you do is obscene.

I cannot imagine feeling such pain again (although I will, perhaps even worse, close to death). Even so, I would not want to have never felt it at all. In The Mask of Motherhood, Susan Maushart writes that, “what [she] gained from childbirth that was ‘of worth’ was inextricably bound up with the pain – and literally unimaginable without it”.

Strange though it sounds, I feel that way, too. The pain I suffered, hateful as it was, is something I have come to treasure. It is not a source of pride as such, but a point of definition. I am not a masochist. Like most women – even those of us who are mothers – I just want to know I exist.

“It is carried by the same nerves; it is conducted through the action of the same neurotransmitters; it is routed to the same areas of the brain. […] It is not more noble or any less painful.”

It is pain that has no unique physiological significance. If that pain is central to the story of how we become mothers, it is because we choose to make it so.

As many will be aware, pain in childbirth is Eve’s curse:

“To the woman he said, I will make your pains in childbearing very severe; with painful labour you will give birth to children. Your desire will be for your husband, and he will rule over you.”

The agonies of labour are not merely punishment for being first to eat from the Tree of Knowledge, but are inseparable from women’s subordination to men. Whatever women endure physically does not make them stronger; it merely serves as a proof of their moral inferiority. Or so the Bible says.

“A large number of women want to avoid pain. Some just don't fancy the pain [of childbirth]. […] Pain in labour is a purposeful, useful thing, which has quite a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.”

Walsh takes his place alongside other male experts, such as Michel Odent, Fernand Lamaze and Grantly Dick-Read, who have claimed to truly understand what it is that labouring women should do and feel. We have moved beyond the Biblical punishment model, but not that far.

Still we have people who will never know what it is like to live in our skin telling us just how much pain our nerves can stand, how much that skin can stretch, how much a woman should bear for the sake of the greater good. It is pure misogyny.

The idea that “wanting to avoid” or “just not fancying” pain is self-indulgent could only ever be applied to women. So-called “natural” childbirth advocates, writes Tuteur, “believe that women (but not men) are improved by agonising pain and diminished by relief. That is cruelty.”

She goes on to note that “an unmedicated vaginal birth is not a feminist statement”, to which one might add, how could anyone think it was?

And yet it is not so clear cut. One of the problems I have in thinking and writing about birth is that I tend to agree with whichever feminist I happen to be reading at the time. Everybody’s right, from Shulamith Firestone with her denigration of the entire reproductive process, to Naomi Wolf, with her breathless veneration of Ina May Gaskin (which stops short, however, of Wolf submitting to a Gaskin-supervised labour herself).

Female bodies aren’t real bodies, not even to feminists. They’re the grounds upon which we test out our theories of power. They’re the paper upon which we write our stories. The labouring body – ultimately female, ultimately other – can be used to prove whichever point you want it to. No wonder men are so eager to control it. No wonder feminists find, that whichever escape route they tunnel out for themselves – natural childbirth, ultra-medicalisation, structure-erasing queer theory – they almost invariably find themselves back where they started.

In The Politics of the Body, Alison Phipps charts the move from a first-wave feminist fight for pain relief in childbirth “as part of a broader fight to free women from the dominion of biology and the tyranny of their reproductive capacities” to the second wave’s critique of medicalisation, which, she argues, ironically ends up converging with, “conservative and religious discourse on childbirth and childrearing”.

There seems to be a horrible inevitability to it all. As soon as feminists have reinforced the dam, a crack appears elsewhere and the leak starts all over again. The principle underpinning this is not, in and of itself, whether birthing women should experience pain, but control of women’s lives and experiences. Unless we can tackle that, misogyny and dehumanisation will overshadow any kind of birthing process.

For instance, Adrienne Rich claimed that“no more devastating image could be invented for the bondage of woman” than an ultra-medicalised labour:

“…sheeted, supine, drugged, her wrists strapped down and her legs in stirrups, at the very moment when she is bringing new life into the world. This ‘freedom from pain,’ like ‘sexual liberation,’ places a woman physically at men’s disposal, though still estranged from the potentialities of her own body.”

Tuteur, on the other hand, argues that pain in childbirth is disempowering because it “robs [women] of the control they value and the ability to articulate other desires”, even going so far as to describe natural childbirth promoters as sadists on the basis that they, “derive satisfaction from observing pain, suffering, or even the humiliation of other women and actively prevent them from seeking relief”.

Pity the labouring woman, caught in the middle of this! Who can she trust? You can’t trust labour itself, what with its terrible unpredictability. But how can you be sure, in a culture that, as Rich observes, places women “physically at men’s disposal”, your own humanity is being respected? Or should that even matter?

Childbirth – which no male body must endure – provides something of a test case for how female bodies and minds may relate to some assumed greater good. For Tuteur, the answer is straightforward: “the achievement really should be a healthy baby – full stop”. For Rebecca Schiller, director of Birthrights and author of All That Matters, the answer is more complex:

“When I say ‘my healthy baby was all that matters’, I am leaving out much, expecting it to be taken as read. That I am incredibly privileged in so many ways. That I had consented to the sex that conceived the baby. That I had access to contraception if I had wanted it. That I decided I wanted to continue with the pregnancy and had access to free, safe abortion if I hadn’t. That I lived in a country that offered me free, expert maternity care should I want it. That I could, just about, afford to pay an independent midwife when I realised the system might not work for me. That I would retain autonomy to make the decisions that I felt were best for me, my baby and my family. That no one would intentionally hurt me while I was in labour, or threaten me, or bully me, or take me to court and strap me against my will to an operating table and cut me open if I declined a suggested course of action.”

My sympathies are with Schiller on this. We have to look beyond one-outcome-fits-all, but the entire issue is incredibly delicate and fraught, involving the play-off of who the mother is (a person) at the moment of birth, and what might happen if she is to be treated as such, as opposed to an inanimate birthing machine.

Pushed to its logical conclusion, the cost to women of seeking to prioritise the physical health of the baby above all else seems to me tremendous. Indeed, you can only do this if you start to view the woman not as a human being, but as an environment. However much one vaunts the idea of informed consent, it is a relatively short step from this to the criminalisation of supposedly “unsafe” decisions made in pregnancy, including the decision not to have a caesarean or not to be induced.

Compensating (rightly) for the censure heaped on those deemed “too posh to push”, Tuteur offers up praise for those who undergo caesareans, noting that in comparison to vaginal birth the mortality risk is lower for the foetus but slightly higher for the woman:

“C-section represents a transfer of risk. […] When offered the choice between risk to their unborn baby and risk to themselves, [the labouring women] chose taking on the risk in an effort to protect the baby. If that isn’t the essence of motherhood, I don’t know what is.”

I understand why she wishes to make this point. It’s a clever reversal of Walsh’s intimation that women who have caesareans are not “proper” mothers and have not really given birth. Nonetheless, it’s a path that still leads us back to the same place, where we celebrate the true mother as the one who is most willing to suffer. The only difference lies in whether we consider the pain of vaginal birth or the mortality risk of caesarean to constitute the worthiest sacrifice.

Tuteur may well be seeking to offer a wholly rational, evidence-based riposte to the intuition-based musings of what she sees as natural childbirth’s matriarchal cult. But as Barbara Katz Rothman points out, biology is not “beyond culture, beyond ideology”:

“When we challenge technological ideology, people hear the sound of the baby being chucked out with the bathwater, fear and return of the angel of death hovering at every birth, fear unchecked fertility and untreatable infertility, women captured and held hostage to some mad biology. When we challenge ownership models of bodily integrity, we hear the enormous fear of someone else claiming ownership.”

To have/be a female body under patriarchy is to be unsafe, yet one must still create a life for oneself – perhaps for others, too – as if this were not the case. The “rational” decision, whatever that happens to be, is always at risk of being appropriated by others for irrational, or at the very least harmful, ends.

It is trite to talk about competing rights where women’s bodily autonomy is concerned. When I look at the position of women and girls in this world – denied subjectivity, space, language – part of me wants the contours of their bodies to be sharp, tight, defended with ferocity. You may not pass through, for I am whole. But then in labour the body still has to soften and release.

“The wall,” writes Nelson of the cervix, “must somehow become an opening”. At this point we are vulnerable to multiple narratives. “When women start on the journey toward childbirth,” writes Wolf, “most can see only two totally distinct doors available to them: the ‘conventional’ door and the ‘natural’ door”.

But there are more doors than that, more openings and more risks. Everything comes at a cost to the story we still try to tell of ourselves as one person, and one person alone.

Birthzillas with attitude

Patriarchy has always driven women slightly insane. Here we are, starving ourselves, cutting ourselves, injecting ourselves with poison, if only to remind ourselves that our bodies are ourselves. We’d be driven mad even without those constant whispers in our ears telling us that womanhood, that thing we thought of as a social reality, may in fact be nothing more than a feeling.

It does not surprise me in the least that pain in childbirth is, for some of us, an objective in its own right. It’s not the love of pain per se. Contrary to what femininity’s cheerleaders might tell you, women are not born revelling in self-hate. It is something we learn then go on to apply to the varied contexts of our lives.

I am, on the face of it, a typical candidate for natural childbirth brainwashing. A white, middle-class woman of the 21st century, born in a wealthy country, I am not someone for whom fear of pain or even death in childbirth has been a constant feature of growing up female.

Nor have I lived in fear of being forced to continue with a pregnancy I did not want or being imprisoned for not treating a foetus with due respect (to be fair, I’ve never tested out just how safe I am from these threats, but make the assumption that, for the time being, whiteness and money are enough to protect me from misogyny’s most vicious moral codes).

If women are imprisoned by their bodies under patriarchy, I’ve at least been able to decorate my own cell, acquire my own creature comforts, even devise my own punishments. I don’t think pain in childbirth is one of them, but I can see how it becomes something on which to focus – a big, memorable event to make institutionalisation that bit more bearable.

Tuteur argues, convincingly, that for many women such as myself, the “birth experience” has acquired a similar status to one’s wedding day, with midwives taking on the role of “wedding planners of birth”.

She conjures up an image of over-privileged, over-anxious, middle-class birthzillas harassing experienced, well-meaning hospital staff with unrealistic birth plans, all the while egged on by ill-informed, overpaid private midwives and doulas.

While Tuteur’s perspective is very much based on the US maternity care model, in which midwives are a luxury as opposed to the norm, I think there are some parallels with how UK women might approach consultants and obstetricians.

Reading Push Back, I cringed at the memory of telling my last consultant that I “didn’t want any unnecessary interventions” during labour. What was I suggesting, if not that the person I was talking to might be so cavalier as to drug me or cut me open just for the hell of it?

Whatever I may think of the way in which structural misogyny infects all of our institutions, that was just rude. Besides, as Tuteur rightly observes, “deciding before labour begins to refuse an epidural is the equivalent of vowing not to use an umbrella next Tuesday”. One cannot plan for the unplannable.

There is, Tuteur suggests, a form of privilege-fuelled narcissism in the way in which women with access to advanced healthcare systems decide to play the role of heroic natural birther:

“Natural childbirth is a philosophy that assumes economic security, ready access to medical technology, and the leisure to construct an “identity” […] It is about the mother and how she would like to see herself, not about childbirth and not about babies.”

Phipps makes a similar observation regarding the class privileges enjoyed by those who work hardest to advance the cause of non-medicalised labour:

“Unimpeded nature […] is deeply marked by privilege, and in rejecting a medicalized birth, middle-class activists confirm their elevated social position since only women who know they are able to give birth safely are able to reject the trappings of technology.”

This is absolutely true. One can only reject an epidural – and seek credit for having done so – if one was made available in the first place. But while such critiques have validity, they require some qualification.

Economic and racial privilege does not just make it easier to give birth in a non-medicalised setting. They make all forms of giving birth easier. A low-paid woman of colour in the US is less likely to have access to a private doula or midwife, but she is also more at risk of coercion and criminalisation within a medicalised setting.

Economic disadvantage may exclude black women from the commercialised natural birth experience, but racism makes them more vulnerable to medicalisation as social control.

An additional problem with Tuteur’s wedding comparison is that in both instances – whether one is castigating the bridezilla or her birth plan-wielding sister – one sees the double bind that women face. Patriarchy sets standards that most of us cannot even aspire to attain. It takes time and money to be the patriarchally-approved perfect bride or perfect mother. But should one have such time and money, one’s achievement of so-called perfection does not count, since it is a mark not of obedience but of privilege.

“Instead of viewing motherhood as a service they willingly give their children,” writes Tuteur, “[natural childbirth advocates] view it as a social identity that they construct for themselves, boosting their own egos in the process.”

Just imagine! Women – mothers, no less – having egos! Next thing you know, they’ll be having opinions! It strikes me as far easier to write off the woman who takes a self-esteem boost where she can find it than to examine why it is that such women are investing so much in these very brief, highly gendered snapshots of their lives. As though without the perfect wedding or the perfect birth, they have no story at all.

The sneering dismissal of women having inner lives as some pointless middle-class indulgence has worked very successfully to undermine the authority of far too many feminist voices. The implication is that, if you care whether or not women are treated like complete human beings, with experiences of their own, you are focusing on some added extra: the icing on the cake of women’s liberation, as opposed to the most basic principle of all.

Why, it is suggested, are you so bothered about being treated like a person, when you could settle for being treated like an automaton, albeit one who is allowed the vote and various other minor perks? Where on earth did you get the idea that how you feel about yourself is of any importance at all?

Witness, for instance, the following extract from a review of Elisa Albert’s After Birth, a novel in which the main protagonist has the temerity to mourn the vaginal birth she wanted but never had:

“After Birth is a textbook example of what I call First World Problem Fiction: The single worst thing that can happen to a woman undergoing a high-risk birth is a skilled medical team paying more attention to what it's doing than to her personal bout of angst.”

Because while a male protagonist might have a deep, existential crisis, with resonance for the whole of humankind, about losing a job or failing to get the girl, a female protagonist is really pushing it to question the politics of how women give birth. Never mind that the assumed limitations imposed by her femaleness may have shaped her whole life up until then. No experience that is exclusively female can be anything other than self-indulgent “angst”.

Giving birth to ourselves

To describe the oppression of women as it really is – how it happens, why it happens – always feels melodramatic and overblown. Words such as patriarchy, misogyny and marginalisation seem exaggerations when we know how interdependent and intertwined the lives of men and women are.

We both know and don’t know the violence of men. It is abuse but it is also the fabric of daily life. The fear we live with is so mundane, so normal, that it becomes background noise, whereas any attempt to describe it is other – shrill, hysterical shrieking. Why do men hate us? Well, we’d rather not say, for what if to say is to justify?

Throughout Push Back, Tuteur remains highly critical of those whom she calls “biological essentialists”. The Oxford English Dictionary defines biological essentialism as: “The belief that ‘human nature’, an individual's personality, or some specific quality (such as intelligence, creativity, homosexuality, masculinity, femininity, or a male propensity to aggression) is an innate and natural ‘essence’ (rather than a product of circumstances, upbringing, and culture).”

It is not difficult to see how such a belief has been, and continues to be, used to justify the subjugation of women. However, it has become increasingly commonplace to see “biological essentialism” misused to mean “any attempt whatsoever to describe female people as biological entities in their own right, as opposed to penis-less men or male-fantasy sex dolls”.

For instance, to associate femaleness with having breasts is not seen as biologically essentialist; to associate it with having a uterus, on the other hand, is. To see the vagina as a birth canal is essentialist; to see it as a hole for penises to enter is not. This rather forces feminists into a corner, for it means that any description of how and why female bodies are exploited becomes a justification for the exploitation itself.

In her absolutely justified attempt to liberate women from feeling that they must embrace undue pain and risk in childbirth, Tuteur falls into the trap of endorsing this patriarchal man/woman mind/body split.

“Natural childbirth,” she writes, “has nothing to do with feminism . . . and everything to do with manipulating women into accepting the profoundly misogynistic notion that women’s worth is determined by their vaginas, uteruses, and breasts, instead of their intellect or the content of their character.”

It is not a form of delusion or mysticism to think that specifically female embodied experiences cannot be separated from intellectual ones. Living both within and as this inseparable mush is what we call “being a person” and women are people, too.

Placing herself firmly on the neoliberal right side of history, Tuteur claims that, “there is no more of a need for women to glory in unmedicated childbirth than there is to glory in unmedicated painful periods”:

“Women have replaced faux achievements with real achievements in every area of human endeavour from universities to concert halls to outer space.”

Good for us! Each of us has more to offer the world than the narrative of her own personal suffering. Even so, I think something is lost in this dichotomy between “faux achievements” and “real achievements”.

Tuteur suggests that, “when you peel back the layers of natural childbirth, lactivism, and attachment parenting, it seems that every aspect is rooted in ideas meant to keep women at home, focused primarily on children, and out of the wider world and equality with men.”

This necessarily implies that the stereotypical world of men is somehow more legitimate and more valuable than the domestic sphere. It also tells women that any validation of their own social and embodied experiences is “essentialism” – that is, a justification for their own marginalisation – whereas male experience is demonstrably valid because men already “have” equality (although quite how and why, according to this analysis, no one could ever know).

I do not think women can be said to have gained parity with men as long as their experiences of socialisation and the body are treated as irrelevant, substandard or somehow not real.

Religion after religion after religion, philosophy, psychoanalysis, psychiatry, postmodernism – we are inundated with narratives that tell us that well, actually the male is the default, the original being, the source of all human consciousness.

Why is this? I don’t think we should underestimate the extent to which this might be over-compensation. Men have potency, virility, whatever bullshit term you want to give the capacity to get an erection but not to give life.

Scratch the surface and you find that 99 per cent of religious belief is one massive mansplain to get around the fact that people with penises are necessarily alienated from the creation of other human beings (the remaining 1 per cent being fear of death). Yeah, but we created everything else, they say. No, you didn’t, we respond. Yeah, but we can hit hardest. And that’s how we end up pretending they’re right.

Of course, it will be pointed out that not all women give birth. Unlike any other social justice movement, feminism is expected to abandon all attachment to words, definitions and analysis because female experiences are too diverse to capture. And yet we do all share one experience in common: being born to someone who is female. It is not indulging in biological essentialism to say that this matters.

As Mary O’Brien pointed out in The Politics of Reproduction, women struggle to identify themselves as a class, remaining all too aware of exceptions and exclusions, while, “man knows himself as some kind of universal being with all kinds of shades of power and promises of immortality which particular men do not and cannot demonstrate”:

“It is precisely this capacity to posit himself as universal, to assert a brotherhood of man, which has permitted men to make the history of man. The historical isolation of women from each other, the whole language of female internality and privacy, the exclusion of women from the creation of a political community: all of these have obscured the cultural cohesiveness of femininity and the universality of maternal consciousness.”

Not all female people are fertile and not all want or will have children, but reproductive difference remains absolutely central to how we constitute a particular social group, with our own meanings and values. One does not have to be a devotee of cultish earth mother myths to recognise the need for linguistic and political organisation around this.

“The female experience is always separate from the universal. No one reads books about childbirth in order to understand human existence. We read Shakespeare. Or one of the great philosophers who write about how people spring from the earth like mushrooms and immediately start drafting social contracts with each other. It’s only woman who has a gender. Man is human. Only one sex exists. The other is a variable, a reflection, complementary.”

One of the reasons I think women have become so invested in “the right birth” for us as individuals is because we are denied any consciousness of our collective status. If we see ourselves as a group at all, it is as the leftovers.

We are so used to the capacity – or even the assumed potential – to give birth being presented as a disadvantage, making us less intelligent, less creative and less economically-productive, that to point out the obvious (that it is our class heritage) sounds insane.

Instead we accept a world that, as O’Brien puts it, “men have fashioned […] with a multiplicity of phallic symbols which even Freud could not catalogue exhaustively”. Penis is everything; all else is but a void.

Maushart describes childbirth as “a lottery”, claiming that, “a woman who gives birth easily deserves as much credit for her ‘accomplishment’ as a woman who moves her bowels easily”.

She is right and it pains me to admit it, since I would prefer to take credit for my own intervention-free labours, even while knowing these are no more achievements on my part than my miscarriage was a failure.

It is pathetic, the tally we keep, as though that is where the meaning lies – not in the fact that you belong to a class that holds the power of life itself, but in whether or not you had gas and air, pethidine, an epidural, forceps, ventouse, a caesarean, whatever it took to get fresh, wriggling personhood out of you and breathing on its own.

What a way to dampen down the post-birth surge, that fleeting moment when you might be able, as a woman, to look at your own body and think: “I am not the Other. I’m the One. Women are the One.”

Loving your birth

On a global scale, childbirth remains murderous, killing over 800 women every day. It’s a tragedy that those of us who have the resources and support to labour in relative safety are hesitant to see the ethical issues surrounding birth in broader class terms, instead behaving as though the most intersectional response would be to nurture a private sense of shame.

We should feel such rage for each and every one of them. Instead we break down what is happening into ever smaller pieces so that we never have to face the whole. We don’t feel a sense of kinship with the tens of thousands who die every year due to unsafe abortion and preventable pregnancy-related causes.

Instead we have the reproductive rights organisations of privileged nations attempting to de-gender the very language of female oppression, as though the erasure of class consciousness works for, rather than against, the liberation of a subjugated class.

Rich argued that, “what we bring to childbirth is nothing less than our entire socialisation as women”. While one can de-gender the experience on a linguistic level, one cannot experience the opening up, the tearing apart, as anything other than deeply, horrifically gendered.

While reading Push Back, I felt, briefly, a creeping sense of doubt. Whose side am I on? There are so many wonderful women, all of them feminists, whose work I have read or to whom I have talked about childbirth, and their perspectives differ so much. So how can I feel so strongly about an issue where I see so much nuance? But then when Tuteur asks this of women, I think there is no need to compromise:

“Be subversive: Love your body as it is.

“Be subversive: Love your birth as it is.”

She is right. Regardless of how greetings-card schmaltzy it may sound, in a male supremacist society, that is the most subversive thing you can do. It is not some self-contained, narcissistic liberation of one. It is an absolute prerequisite for writing our own stories, and for gaining acceptance as people whose experiences have validity regardless of the constraints under which we are placed.

Be subversive: Love women, not just for the spaces they make, but the boundaries they set. Embrace not the void in which you see yourself reflected, but the other person, with all of her contours, not in pieces, not in pain, but complete in her own right.